Queen's Medical Centre

Updated 4 March 2026

Date of assessment: 20 to 21 May 2025.

Queen's Medical Centre provides a range of NHS hospital services. This assessment looked at maternity services to provide an up-to-date rating of this assessment service group, which we rated as requires improvement. The rating of maternity has been combined with the ratings of the other services from the last inspections. See our previous reports to get a full picture of all the other services at Queen's Medical Centre.

The rating of Queen's Medical Centre remains requires improvement. In our assessment of maternity services, we found learning was not always based on openness and was not always shared effectively. Security arrangements did not always keep women and their babies safe. There were gaps in consultant staffing. Managers did not always make sure staff received training and regular appraisals. Staff did not always manage medicines well. Leaders did not always support staff well-being. Leaders were not always visible within the service and were sometimes perceived as unsupportive. Staff were encouraged to feedback but not always heard. This encouragement was not always based on openness and was not always effective.

However, women were involved in assessments of their needs and these were reviewed regularly throughout the pregnancy journey. Care provided was evidence based. Women were supported in healthy living. Staff made sure women understood their care and treatment to enable them to give informed consent. Women were treated with kindness and compassion. Women consistently had nothing but praise for their experience throughout their pregnancy, birth, and postnatal experience. Maternity services provided information women, and their families could understand. Women received fair and equal care and treatment because the service worked to reduce health and care inequalities through training and feedback. Women were involved in planning their care and understood options around choosing to withdraw or not receive care. Managers worked with the maternity and neonatal partnership to deliver the best possible care and were receptive to new ideas.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in the following areas:

• Safe care and treatment – in relation to medicines management and the security.
• Good governance – in relation to organisational culture, staff well-being and engagement, and the visibility of leadership.
• Staffing – in relation to consultant staffing arrangements and compliance with safeguarding training requirements.

Updated 10 February 2025

The Queen’s Medical Centre is operated by Nottingham University Hospitals NHS Trust. The maternity service sits within the division of family health and provides a range of services from pregnancy, birth, and post-natal care. There are inpatient antenatal, intrapartum, and postnatal beds available for women. Fetal medicine service is based at the Queen’s Medical Centre campus.

Ward B26 is an 18 bedded antenatal ward and holds the day assessment unit and admissions for elective caesarean sections and beds for women’s whose babies were on the neonatal unit. Ward C29 is a 26 bedded postnatal ward which includes transitional care cots. The labour suite is located on the same floor as B26 and has maternity operating theatres, 9 beds for women in labour plus four observation beds, and a bereavement suite. The triage and induction suite are also based in the labour suite, as is the Sanctuary birth centre which is a four bedded midwife led unit.

Queens Medical Centre welcomes on average 3,700 newborns each year. Community midwifery services are provided by teams of midwives and there was a separate homebirth team.

The on-site assessment of the service took place on 20 and 21 May 2025, the inspection team visited all areas within the maternity service and spent time with both the community and homebirth teams. We spoke with 32 members of staff and reviewed 10 patient records.

The inspection team comprised of a senior specialist, three inspectors, 2 midwifery specialist advisors and one consultant specialist advisor.

Our rating of maternity services remained the same. We rated them as requires improvement. We found breaches of regulations relating to security; organisational culture, staff well-being; engagement; visibility of leadership; consultant staffing and safeguarding training requirements.

Safe:

We rated safe as requires improvement. Learning was not always based on openness and was not always shared effectively. Security arrangements did not always keep women and their babies safe. There were not always enough staff, we found gaps in the consultant staffing. Managers did not always make sure staff received training and regular appraisals. Staff did not always manage medicines well. However, staff understood how to manage risks as far as practicable. Facilities met the needs of people and were clean and well-maintained.

Effective:

We rated effective as good. Women were involved in assessments of their needs. Staff reviewed assessments taking account of women’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in women’s care for the best outcomes and smooth transitions when moving services. They monitored women’s health to support healthy living. Staff made sure women understood their care and treatment to enable them to give informed consent.

Caring:

We rated caring as good. Women were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. Women had choice in their care and were encouraged to maintain relationships with family and friends. Women consistently had nothing but praise for their experience throughout their pregnancy, birth, and postnatal experience. Staff responded to people in a timely way. However, leaders did not always support staff wellbeing.

Responsive:

We rated responsive as good. Women were involved in decisions about their care. The service provided information which women, and their families could understand. Women knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. Women received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. Women were involved in planning their care and understood options around choosing to withdraw or not receive care.

Well-led:

We rated well-led as requires improvement. Leaders were knowledgeable but they were not always visible within the service and sometimes perceived as unsupportive. Staff were encouraged to feedback but not always heard. However, the trust had a shared vision and culture based on listening and learning. Staff understood their roles and responsibilities. Managers worked with the maternity and neonatal partnership to deliver the best possible care and were receptive to new ideas.

Updated 14 March 2019

Our rating of this service stayed the same. We rated it as good because:

• Clinical and operational staff used an effective system to ensure medical patients cared for as outliers on surgical wards received regular medical reviews and individualised care. This included multidisciplinary care and reviews from specialist teams such as allied health professionals and the rapid response psychiatry team.
• The safeguarding team were working with regional partners to standardise safeguarding training in line with new intercollegiate guidance. This would ensure local practice was benchmarked against national standards.
• The patient safety team had a key role in maintaining and improving safety standards, including through benchmarking and acting on local risks. The team used the human factors analysis and classification system as a tool during the root cause analysis of serious incidents to ensure they fully understood the actions and thought processes of staff.
• Multidisciplinary staff had introduced a range of initiatives to improve nutrition and hydration, including of older patients, in addition to standard use of the malnutrition universal scoring tool. This included a gold standard programme to ensure patients had access to nutritious food that was culturally appropriate and served during facilitated mealtimes to promote social contact.
• Professional development and education were clear priorities for medical care. Patient outcomes had demonstrably been improved as a result and staff were able to pursue more advanced qualifications and training.
• Multidisciplinary working was embedded in care services and a diverse range of specialist teams had established links with each other to address gaps in care provision and to improve patient outcomes and experience, including when patients transitioned to community care.
• The integrated discharge team worked across the hospital to improve access and flow through a more robust, patient-centred model of discharge planning and delivery. This was a multidisciplinary team that supported ward teams to establish more advanced understanding of discharges and had established a team of trained discharge coordinators.
• Staff routinely went above and beyond their responsibilities to provide additional care for patients that demonstrated the culture of compassion and kindness. This included setting up a clothes bank for patients with limited means to buy new clothes, fundraising for blankets for patients going home in the winter and liaising with the British Red Cross to support a patient at the end of their life.
• Specialist teams were increasingly aware of population-based health models and explored the needs and demographics of their target population to shape care and treatment, including health promotion interventions.
• A range of work had been completed to assess and improve accessibility to all elements of the service. This included improved access to mental health and drug and alcohol dependency care, language support and strict standards for information access. NHS England had certified the communications team as meeting The Information Standard, a national standard for health and social care information.
• The integrated discharge team and specialist services had developed discharge improvement projects based on the needs of their patients. The frailty service had experienced significant improvements, including a 5% increase in the pre-noon discharge rate and a 25% increase in use of the discharge lounge.
• Staff spoke positively of the trust’s vision and strategy and had adapted local variations to meet the trust’s objectives and reflect the needs of their patients. This included specialist teams not based on specific wards and reflected the enthusiasm of staff to deliver sustainable care.
• Governance processes and structures were well-established with clinical and operational oversight and assurance provided by a series of committees and multidisciplinary groups. Governance, risk and quality management processes demonstrably led to improved practice.

However:

• The overall nurse vacancy rate was 19%, which reflected wide variations between specialties including one ward with a 50% vacancy rate.
• There was a lack of assurance around fire safety risk, including staff understanding of evacuation processes and training.
• From June 2017 to May 2018, patients at Queen's Medical Centre had a higher than expected risk of readmission for elective admissions and a higher than expected risk of readmission for non-elective admissions when compared to the England average.
• Some teams did not feel part of the broad improvements and innovative projects taking place in the hospital and did not feel they were valued by the trust or their colleagues.

Updated 14 March 2019

Our rating of this service stayed the same. We rated it as good because:

• Children’s and neonatal services had appropriate arrangements for investigating incidents and shared the learning from them.
• The services had a well- developed approach to assessing and responding to risk. Staff used a paediatric early warning system to take action on any deterioration in child health. There was a well-established and understood approach to managing and escalating suspected sepsis. Mental health risks were recognised and the service worked well with mental health professionals.
• People’s care and treatment was focused on achieving good outcomes, and this was supported by learning from clinical audit, and initiatives to improve clinical pathways.
• Parents and children told us that nurses and doctors were kind and took time to talk to them and explain care arrangements. The services did as much as possible to ensure that children were comfortable and they responded quickly if a child or young person was in pain. The services helped young children feel settled through play specialists and a variety of volunteers who entertained them, such as Spiderman, a magician, and a therapy dog.
• The services took a holistic approach to childhood and teenage cancer treatment and offered emotional support and arranged relevant social activities for them.
• Children generally had access to timely initial assessment, test results, diagnoses and treatment. Waiting list performance for the service was better than the national target of 92% of patients being definitively treated within 18 weeks (incomplete pathway). The cancer service was responsive and timely.
• Senior leadership capacity for children’s and neonatal services was improving and the leadership team was starting to address significant strategic risks and issues, for example how to ensure staffing and skills levels long term.

However:

• Some beds on wards were not open to children because there were insufficient staff to manage them safely.
• Vacancy rates and turnover figures were high for doctors in neonatal services. The service was advertising for three new neonatologists to give the services some resilience across City and QMC sites in 2019.
• Outpatient appointments did not always run on time and the service did not inform families or display wait times publicly. The outpatient waiting area was very crowded.
• Not all services were available 24/7 and outpatient and day surgery appointments were predominantly during the week between 9am and 5pm.
• Lack of out of hours access to paediatric interventional radiology meant that some babies needed to be transferred to other hospitals, and this had been on the service’s risk register for three years.
• Arrangements for MRI scans 48 hour after tumour removal were not sufficiently formalised for children who needed a general anaesthetic.
• Children and young people’s matters did not have a strong profile at Board level and lacked specific non-executive director representation.
• Processes around monitoring that products were kept at a safe temperature in fridges were not robust.

Updated 14 March 2019

• The service had innovative and leading practices that improved the experience and outcomes for patients and their families.
• The service was a national lead in critical care practice and guidance.
• The service had enough staff, who had completed required training. Staff were supported by managers and had annual appraisals.
• On both units the environment was clean, tidy and equipment was readily available, clean and well maintained.
• The service stored and administered medicines well.
• Staff worked well in multidisciplinary teams and provided compassionate, appropriate and individualised care to ensure good outcomes for patients.
• Staff provided emotional support to patients and relatives to help them to manage through a traumatic experience.
• The service responded where there was a need for improvement. For example, staff carried out many local audits, compared results to national target and set actions to improve the service.
• Managers supported staff, promoted learning from incidents, concerns and complaints and used available information to improve to the service.

However:

• The service had become accredited to deliver the post registration critical care module and 37% of staff were due to complete the course by March 2019. However, there was a risk that the course would not be funded after March 2019 and the service would not be able to ensure that 50% of staff had completed the course.
• Follow up clinics were not available for patients discharged from critical care. Managers planned to create follow up clinics and had created a new coordinating specialist nurse for continuing care role. Follow up clinics for critical care patients had not received support from commissioners.
• Discharge summaries did not include personalised rehabilitation goals and were not consistently sent to patient’s GPs at the time of discharge.
• The lack of a critical outreach team service overnight had put a strain on the capacity in the adult intensive care unit and higher demand on the critical care consultant.
• Training completion rates for medical staff were lower than expected.
• The service had higher than expected numbers for patients transferred out of the unit for non-clinical reasons and out of hours discharge to the ward from the adult intensive care unit due to activity and continual high number of admissions to the unit.

Updated 14 March 2019

Our rating of this service improved. We rated it as good overall because:

• The trust had taken steps to improve consistency in completion of patient’s nutritional screening and the completion of nutrition and fluid charts.
• Improvements had been made to the availability of patient information leaflets, including those in other languages and accessible formats.
• Staff followed policies and procedures to ensure medicines were administered appropriately to make sure people are safe.
• The trust had implemented care plan documentation specific to end of life care.
• The Trust had increased their number of palliative care consultants to improve availability of a senior end of life care clinician.

However:

• Do Not Attempt Cardio-Respiratory Resuscitation (DNACPR) forms were not always completed correctly.
• Conversations with patients and relatives regarding DNACPR decisions were not always documented in patients’ medical record.
• Mental Capacity Act assessments were not always completed for relevant patients when making DNACPR decisions.
• Care plans, although personalised and improved since last inspection, did not always document conversations about patient’s mental health needs, spiritual and pastoral needs.
• There was a lack of audit processes to monitor the effectiveness of end of life care.
• The service did not monitor or audit if end of life care patients died in their preferred place of death (PPD).
• The trust was not providing a HPCT seven days a week. However, this would commence in April 2019.

• The service did not record palliative or end of life care patients as delayed transfers of care

Updated 8 March 2016

Overall, we judged the outpatients and diagnostic imaging services to be good.

There were reliable processes to protect patients from avoidable harm. Departments were mostly clean and hygienic, and risks to patients attending appointments were monitored and well managed. Staffing levels were appropriate to the needs of each outpatient clinic, but there were unfilled vacancies in radiology which had an impact on the service. Patient records were not always well managed; paper files were overdue for collection and secure storage and patient letters were sometimes misfiled.

The care and treatment of patients was delivered in line with current evidence based practice and recognised national guidance. Staff had good opportunities for personal and professional development. There was effective multidisciplinary working in many departments. There were few seven day services. Staff supported patients in a caring, kind and compassionate way. They respected patients privacy and dignity, and made sure that people's individual needs were met.

Services were largely planned to meet people's needs. While the trust was able to provide timely assessments for people with non-urgent conditions, the trust did not meet national standards for urgent referrals. There were higher than average rates of cancelled appointments, both by hospital staff and patients. The hospital had put in place some innovative methods aimed at reducing cancellation and unattended appointments. There were largely effective governance structures, but not all risks were recorded and addressed. There was work in progress to re-design the outpatient pathway and improve the trust-wide outpatient service. Staff were committed to their roles and in most departments there was a positive, supportive working culture. There was good staff and public engagement, and a focus on continued improvement.

Updated 15 September 2021

Updated 15 September 2021